Heparin-Induced Thrombocytopenia in a Chronic Hemodialysis Patient with End-Stage Renal Disease / 대한신장학회지

ABSTRACT

Hemodialysis (HD) patients continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT). However, HIT is very rare in chronic HD patients with end-stage renal disease (ESRD). The authors report the case of a chronic HD patient with ESRD who developed HIT complicated by recurrent thrombocytopenia and significant bleeding episodes. A 67-year-old man with diabetic ESRD on chronic HD suddenly developed recurrent acute bleeding episodes and severe thrombocytopenia (platelet count <1.0x10(3)/uL) 2 months prior to presentation. These bleeding episodes and the thrombocytopenia always occurred 1 week after initiating HD with heparin, and improved within 1 week of discontinuing heparin. HIT was confirmed by ELISA for anti-heparin/platelet factor 4 antibody. HD was conducted successfully and thrombocytopenia did not occur after switching argatroban for heparin. This case report suggests that clinicians must consider HIT in the differential diagnosis of thrombocytopenia during maintenance HD.